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What can ADHD & ODD look like in under 5s?(12 Posts)
DS has a SALT issue which he's been getting therapy for for the last 2 1/2 years. He is definitely improving. There's absolutely no concern for his receptive language and he's got a good vocab, uses sentences, etc.
However, his preschool (in the US so he doesn't start school until 2013) has been having a nightmare of a time with him and he's exhibited behaviors there that are out of control and very out of the norm for him. Three times when I've picked him up he's been totally out of control, dumped toy bins over, ran around the room, stuck his tongue out to touch a mirror, etc. The teachers said he'd kicked at children in class, headbutted (which for him is more like head pushing) and was a nightmare. I don't know why they didn't call me. He attends school 3 afternoons/week. Those 3 times were particularly bad but the school says he also has problems with keeping to his personal space and will roll around on the floor, touch other kids, etc during circle time/story time. They also say he doesn't have good fine motor skills - which I knew but thought would improve with practice at school.
I will say up front that he's definitely got a temper on him (as do his DPs) and DH most likely would have been diagnosed ADHD if they'd been doing that 40 years ago. DS fidgets, chews on toys (we've substituted bite stick things which he's happy to use), and is always on the go. He's happy to sit still for things he likes like doing Lego, puzzles and reading books. He's attended mommy & me classes for 2 years with no major incidents and the drop in daycare we used to use @ 10 hours/week didn't have any problems that I'm aware of.
We went to a developmental pediatrician on Thursday who said borderline ADHD and ODD. The ADHD wasn't a surprise. The teachers are adamant he's got ODD because he doesn't want to do the activities or sit still when he should. I think he doesn't want to sit still because he has a hard time doing the work and he's a bit of a perfectionist. He did the tasks the Dr. asked him to do with no problems until she asked him to draw a picture of himself. He has a hard time drawing and basically asked why he should since she could see him. I actually thought it was pretty funny (it wasn't said in a mean way) but she said it was defiance because an authority figure asked him to do something and he refused (he did eventually draw a face. Badly.). The doctor said that ODD is a refusal to do something when asked. DS says no a lot but will do as he's asked without any huge issues 95% of the time. I had the impression that ODD was more serious than that.
He's going to get an OT eval just as soon as I can get an appointment. And we're going to get a referral for a psychologist to work on impulse control/ODD/ADHD issues.
Holy smokes, this is long. My real question is, I guess, what can ADHD and ODD look like in a young child?
Thanks if you made it this far!
A few questions
1.Has he had a sensory evaluation? Most nurseries and schools are blissfully ignorant of the sensory issues that can cause major behavioral issues in young kids.
2. The motor issues - is he getting help for these as they can cause a child to play up in sheer frustration?
3. Has he been assessed for ASD?
4.Do you keep a diary to identify triggers for bad behavior - this can sometimes be REALLY enlightening as you get to see the patterns over time.
I'd want him to see an OT with expertise in sensory integration & dyspraxia if he were my child, before I'd accept an ODD diagnosis -particularly as you mention SALT issues. The NAS actually recs that you ring them if you get this diagnosis of ODD - I'd take their advice in your shoes.
My kid in the wrong environment can look to the untrained eye as if he has ADHD - he deffo doesn't it's all sensory. In his case noise/pitch is the key trigger but it can be any of the 8 senses.
Part of getting the OT eval is to look at his sensory issues. I did the checklist and he definitely ticks a bunch of boxes. I'm hopeful the OT will also be able to work on his fine motor and alleviate some of those issues - I truly think some of it stems from his frustration at not being able to do the writing/crafts well. The preschool thinks it is sensory and lent me The Out of Sync Child. Some of it sounds familiar, some doesn't. Again, I'll be relying on the OT for guidance on it. Dyspraxia is definitely on the table.
When we (me, DH, and both teachers) did the ADHD checklist he came in just under the threshold.
He's been assessed for ASD and it's come back negative. The developmental pediatrician doesn't think that's an issue.
I haven't kept a formal diary but the 3 awful days all came after an unusual day - i.e. grandparents visit, field trip, etc. I don't get much of any feedback from the school except to say how disruptive DS is and on the truly bad days I get pulled in to get the whole rundown.
Now I'm at the point that every little thing he does I panic about. He certainly seems within the norms of other 4 1/2 year olds at library story time and other group stuff. I just wish I knew what happened in the preschool that generates his behavior.
I really don't think he's got ODD but I've been reading that it often goes with ADHD so I'm not sure what to think. This week I'll be contacting some psychologists who can take a closer look at him and hopefully give us and him some techniques to help his impulse control and personal space issues. We're in the US so no NAS for us.
The other thing is the SALTs (3 separate people here) all say he works hard, stays on task (or is easily redirected) etc. Two of the sessions are 1-1 one is 3-1 so much smaller groups.
Aargh. I guess I really need to wait and see what the professionals think. In the meantime I'll just live in fear of preschool pickup.
Did the developmental Paed explain why he didn't think he has ASD? I am just wondering whether the behavioural problems are part of a sensory or social overload? Personally I am suspicious of the ODD diagnosis, I think it is more of a symptom of/reaction to the difficulties experienced rather than a diagnosis in itself. See http://www.caddac.ca/cms/video/parents_player.html for more on this. I am interested in the fact that your boy saw no reason to draw himself because he was 'there'. Funny and insightful, yes, but potentially a sign of not understanding why other people might ask things? It makes me think of ASD. Ditto the problems dealing with the various demands of nursery and the response your ds is having to them. I wonder whether a second opinion might be valuable for you.
Handy I was pondering much the same sort of thing on the way back from my school run. That is are PDA and and ODD actually the manifestation of mismanaged other sn?
Not that alleviating distress caused by disability is always possible, but the underlying cause seems ??
Just read that back.
What sort of world do I live in that this is my idle pondering
I know of one child diagnosed with an ASD who the pead had only seen once for one 15 min appointment. The child has no overtly autistic behaviours. So I don't think it's only in the states that messy dx'ing is seen. Her mother who is very well informed is not sure if dx is good.
My own experience of the dx process has been very thorough though.
Thanks for all the responses. I'll have a look at the links if we manage to keep power on thanks to Hurricane Sandy.
The borderline ADHD/ODD decision is right now meant to be a baseline. The idea is that once we get the OT in place and a psychologist's insight combined with some strategies for DS to better manage his behavior in 6 months (or whatever our time frame is) we should see some improvement.
zzzzz, thanks for thinking of us on your school run.
Nobody at any point has mentioned meds.
As for ASD, again, I'm hopeful the psychologist will be able to confirm/deny whether or not DS has it. He certainly plays with other kids in small group situations and initiates conversations. He does have his preferred topics of conversation but not to the exclusion of everything else and he's broadened his interests as he's both got older & improved his speech. He's also more of a follower than a leader from what I've seen on the playground/group situations. He comes up with his own games to play good guy/bad guy with legos, on the playground, etc. The developmental ped ruled it out based on the preschool teachers input and her observation of him (approx. 1 1/2 hours).
As many of you have mentioned, I also believe the ODD is a manifestation of other issues.
I guess we're lucky in that we're getting referrals to different people who can see him and hopefully come to some consensus.
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